Prolonged labour: Its management and prognosis

Summary

• (1) The results obtained in over 600 patients whose labours were allowed to continue up to or exceeding 48 hours at the Rotunda Hospital over a nine year period are presented.

• (2) The maternal results were satisfactory. There was no seriously ill patient amongst the booked cases but one maternal death and one seriously ill patient amongst the unbooked cases. In both of these instances supervision of the labour was quite outside the hospital control in the earlier stages.

• (3) The foetal results were carefully reviewed with special emphasis on a number of avoidable stillbirths. Particular attention was drawn to the connection between prolonged labour and postmaturity and the increased hazard which this presents in regard to the baby.

• (4) Age and parity were considered and as usual in any series of prolonged labour it was found that primigravid patients were in the vast majority and, also, that increasing age tended to increase the incidence of the condition.

• (5) A number of points in the general management of labour were considered with particular stress on the optimum time for the first active interference. It was considered that at the 24 hour stage the whole progress of the case should be fully assessed by the carrying out of vaginal examination under anaesthesia, and the formulation of a definite policy of management.

• (6) The place of the vacuum extractor in the management of prolonged labour was discussed in detail; attention being drawn not only to the advantages of the use of this instrument but also to the risks and to the limitations in its use.

• (7) General supportive measures were briefly discussed with special reference to the need for labour ward supervision and the avoidance of dehydration and infection.